A hospice nurse is a registered nurse or licensed practical nurse who cares for people at the end of life, where the goal is comfort rather than cure.
Medicare defines hospice patients as terminally ill, with a life expectancy of 6 months or less if the illness runs its normal course.
This guide explains what hospice nurses do, the roles hospices staff, who hires them, what the work asks emotionally, and how the career grows.
What is a hospice nurse?
A hospice nurse is a registered nurse (RN) or a licensed practical or vocational nurse (LPN/LVN) who cares for patients at the end of life.
Medicare's hospice rules define a terminally ill patient as one with a medical prognosis of a life expectancy of 6 months or less if the illness runs its normal course (42 CFR 418.3).
Hospice nursing aims at comfort, and Medicare's hospice regulations describe palliative care as patient- and family-centered care that optimizes quality of life by anticipating, preventing and treating suffering.
Hospice nurses hold a state license.
Registered nurses usually take one of three education paths — a bachelor's degree in nursing, an associate's degree in nursing, or a diploma from an approved program — and must be licensed.
LPNs/LVNs complete a state-approved educational program and pass an exam to be licensed.
Within a Medicare hospice, nursing services must be provided by or under the supervision of a registered nurse (42 CFR 418.64(b)(1)), so LPNs work under RN supervision.
Pay runs through the registered-nurse data.
BLS's OEWS for May 2025 puts the median for registered nurses (29-1141) — the group hospice RNs sit inside — at $46.90 an hour, or $97,550 a year, and OEWS has no hospice-only nurse wage.
The OEWS home health care services industry row shows a median of $40.83 an hour ($84,930 a year).
The hospice nurse salary page carries the full BLS tables.
What does a hospice nurse do?
The job runs through the interdisciplinary group, or IDG.
Every Medicare hospice IDG must include a doctor of medicine or osteopathy, a registered nurse, a social worker, marriage and family therapist or mental health counselor, and a pastoral or other counselor.
The hospice designates an RN in the group to coordinate care (42 CFR 418.56).
Assessment starts fast.
The hospice RN must complete an initial assessment within 48 hours after the patient elects the hospice benefit, and the IDG must complete the comprehensive assessment within 5 calendar days (42 CFR 418.54).
That assessment covers physical, psychosocial, emotional and spiritual needs, includes an initial bereavement assessment of the family, and is updated at least every 15 days.
The IDG also reviews, revises and documents the plan of care at least every 15 calendar days (42 CFR 418.56(d)).
Day to day, the work is symptom control.
Hospice patients have the right to effective pain management and symptom control for conditions related to the terminal illness (42 CFR 418.52(c)(1)).
Medication and documentation round out the week.
When controlled drugs are first ordered for a hospice patient at home, the hospice must give the family written policies on managing and disposing of them and document the discussion in the clinical record (42 CFR 418.106(e)(2)).
Hospice nursing roles: case management, on-call, admissions and the IPU
Medicare hospice pays four levels of care — routine home care, continuous home care, inpatient respite care and general inpatient care (42 CFR 418.302).
Hospice nursing roles line up with those settings more than with hospital-style units:
- Coordinating RN (case management). The hospice designates an RN inside the IDG to coordinate care, and that nurse works the 15-day plan-of-care cycle with the rest of the team.
- Admission nurse. New patients start with an RN initial assessment within 48 hours of election and a comprehensive assessment within 5 calendar days. For the initial 90-day period, written certification of terminal illness must come from the hospice medical director, a physician designee or a physician member of the IDG, together with the attending physician if the patient has one (42 CFR 418.22(c)). Admission nursing covers the assessment and intake work on the hospice's side of that process.
- On-call and triage nurse. Hospice nursing services must be routinely available 24 hours a day, 7 days a week (42 CFR 418.100(c)(2)), which is why hospices staff on-call and triage nurses for after-hours symptom calls.
- Continuous care nurse. Continuous home care is covered only during brief periods of crisis, must be predominantly nursing care, and requires a minimum of 8 hours of care in a day to be paid at that level (42 CFR 418.204(a)).
- Inpatient unit (IPU) nurse. In a hospice's own inpatient facility, when at least one patient is receiving general inpatient care, each shift must include an RN providing direct patient care (42 CFR 418.110(b)). Inpatient respite care cannot be reimbursed for more than five consecutive days at a time (42 CFR 418.204(b)), which bounds respite assignments; IPU work runs on the RN-per-shift rule above.
- Facility-based hospice nurse. When a hospice serves nursing home residents, hospice staff coordinate orientation of facility staff in comfort and pain control, symptom management, death and dying, under a written hospice-facility agreement (42 CFR 418.112) — hospice nursing jobs are not all home-visit jobs.
Who hires hospice nurses?
Medicare-certified hospices are the employers these federal rules cover, and one rule shapes the employment structure.
A Medicare hospice must routinely provide substantially all core services — nursing, medical social services and counseling — directly by hospice employees, using contracted staff only to supplement employees in extraordinary or non-routine circumstances (42 CFR 418.64).
Since nursing is one of those core services, hospice nursing is hospice-employee work in the routine case, with agency and contract nurses limited to that supplementing role.
The federal rules this guide cites put the work in three settings: patients' homes, nursing homes serving hospice patients under a written agreement (42 CFR 418.112), and the hospice's own inpatient facility (42 CFR 418.110).
Expect a background check and structured onboarding.
Hospices must obtain criminal background checks on all employees with direct patient contact or access to patient records.
That follows state requirements or, where a state sets none, happens within three months of employment for all states the employee lived or worked in during the past 3 years (42 CFR 418.114(d)).
New hires get orientation to the hospice philosophy, a job-specific orientation, and a competence assessment, and the hospice keeps a written description of the prior 12 months of in-service training (42 CFR 418.100(g)).
If you run a hospice and need to hire for this role as an employer, start from the hiring hub.
Nurses and nursing students: open roles are listed on the hospice nurse jobs board.
What it takes emotionally
The clinical reality is that every Medicare hospice patient is defined as terminally ill, with a prognosis of 6 months or less, and the goal is comfort (42 CFR 418.3).
Deaths are expected.
The nurse's job is a comfortable, supported death and a family that understands what is happening.
The family is part of the care unit.
Medicare's hospice regulations describe the care as patient- and family-centered, the comprehensive assessment includes the family's bereavement needs, and bereavement services remain available to the family up to 1 year after the patient's death (42 CFR 418.64(d)(1)).
Nurses see grief at close range, before and after a death.
The schedule adds strain of its own.
Because nursing services must be routinely available around the clock, every Medicare hospice carries evening, overnight and weekend coverage in some form, and on-call shifts can interrupt sleep and family plans.
The job's own structures are the support system.
The IDG rule puts a physician, a registered nurse, a social worker (or a marriage and family therapist or mental health counselor) and a pastoral or other counselor around the same table for hard cases (42 CFR 418.56).
The bereavement program is a required structure, not an afterthought.
If you would carry the on-call pager, it is fair to ask a prospective employer how coverage rotates before you accept an offer.
Hospice vs home health nursing
The dividing line is the goal of care.
Medicare hospice serves people with a prognosis of 6 months or less and aims at comfort.
Medicare home health instead requires patients to be confined to the home and to need intermittent skilled nursing care or qualifying therapy, among other conditions (42 CFR 409.42).
The paperwork differs too.
Home health RNs must make the initial assessment visit within 48 hours of referral, of the patient's return home, or on the ordered start-of-care date (42 CFR 484.55(a)).
The comprehensive assessment must incorporate the current version of OASIS (42 CFR 484.55(c)(8)) — OASIS-E2, in effect since April 1, 2026.
It is due no later than 5 calendar days after start of care and, except for therapy-only cases, must be completed by an RN (42 CFR 484.55(b)).
Hospice has its own 48-hour RN assessment and 5-day comprehensive assessment, focused on physical, psychosocial, emotional and spiritual needs plus the family's bereavement needs.
The default setting for both is the patient's home, and BLS notes that RNs in home health travel to patients' homes.
Hospice adds pieces the home health rules this guide cites do not include: an inpatient facility setting, a continuous-care crisis level and a 24-hour nursing availability rule (42 CFR 418.100(c)(2)).
The assessment clocks look similar across the two settings; the goals of care do not.
How to grow in hospice
Hospice nursing runs on licensure first.
RNs usually take one of three education paths — a bachelor's degree, an associate's degree, or a diploma from an approved program — and must be licensed.
LPNs/LVNs complete a state-approved educational program and pass an exam to be licensed.
Certification is voluntary — no rule this guide cites requires it — but real: HPCC's CHPN (for RNs) and CHPLN (for LPN/LVNs) are hospice and palliative nursing credentials that sit on top of a nursing license, and neither replaces one.
The outlook tracks registered nursing overall: BLS projects 6% growth for registered nurses from 2025 to 2035 and expects RNs to remain in demand in home healthcare settings because many older people prefer to be treated at home.
The growth projection covers registered nurses as a whole — BLS's OEWS has no hospice-only nurse wage.
Nurses who move into management can land in roles BLS groups under medical and health services managers (11-9111) — the broad BLS category for health services management, not a hospice-only figure.
That category's 2025 median was $123,860 a year, with 24% projected growth for 2025-35.
Inside a hospice, the administrator is a hospice employee appointed by and reporting to the governing body, with the education and experience that body requires (42 CFR 418.100(b)).
Career information, not licensing, legal, medical, benefits or tax advice. Confirm RN or LPN licensure with your state board of nursing, certification details with HPCC, and hospice rules with CMS.
Rules change